Thread by @BillHanage

The last few weeks it has been clear the U.K. is sliding into a pandemic resurgence, and is very poorly placed to deal with it 1/n theguardian.com/politics/2020/…

Why? Because testing has collapsed. The plans, focusing on symptomatic contacts, were flawed IMO, but even these cannot now get a test 2/n

Meanwhile schools are back, with minimal fig leaves of infection prevention. Without testing asymptomatics we will never know how many outbreaks there are there, but schools *will* add to transmission cdc.gov/mmwr/volumes/6… 3/n

(This is not a reason to close schools forever, it is a reason to keep transmission low enough to allow schools to remain open, like they are in NZ, SK, Denmark etc Bluntly education is more important than Pret) 4/n

Now some more epi observations. A doubling time of ~7 days suggests an Rt somewhat more than is currently reported. But it’s hard to be definitive. Why? The messed up testing 5/n

As testing collapses it takes with it the state of ‘situational awareness’ which is so vital to handling any emergency. In infectious disease it is essential to understanding how risks are changing with time 6/n

The U.K. has talked up a ‘whack-a-mole’ approach to targeted shutdowns. This is not necessarily a bad idea, but it falls apart without testing. You can’t whack a mole if you don’t know where it is, duh 7/n

I should be clear that testing improved so much over the summer that a vastly larger fraction of the less severe cases have been identified, mostly in younger people. Action in the spring took place at a much later stage of the epidemic curve 8/n

But that’s why the lack of testing matters so much. If you see the virus coming you can take action early. If you wait for those lagging indicators of hospitalizations and deaths you’re already too late. We should know that from too much bitter experience 9/n

While I am glad the @GOVUK or at least some people within it seem to be taking it seriously, they will struggle to overcome months of confused infantilising messaging about ‘world beating’ testing and ‘moonshots’. The virus doesn’t pay attention to news briefings 10/n

Instead of over promising and under delivering, focus on being adequate to the task. Stop pretending things will be ‘over by Christmas’ and be straight with people. There are testing times ahead in both senses of the word 11/end